Archives of orthopaedic and trauma surgery
-
Arch Orthop Trauma Surg · Apr 2016
Long-term follow up of single-stage anterior cruciate ligament reconstruction and high tibial osteotomy and its relation with posterior tibial slope.
Open-wedge high tibial osteotomy is considered to be an effective treatment for medial compartmental osteoarthritis. It is generally admitted that tibial slope increases after open-wedge high tibial osteotomy and decreases after closing-wedge high tibial osteotomy. Young patients with anterior cruciate ligament (ACL) deficiency along with medial compartment osteoarthritis need a combined procedure of ACL reconstruction along with high tibial osteotomy to regain physiological knee kinematics and to avoid chondral damage. ⋯ Our study has shown that decreasing the tibial slope >5° compared to pre-operative value has functionally favourable effect on the reconstructed ACL graft and outcome. It is known that increasing slope causes an anterior shift in tibial resting position that is accentuated under axial loads. This suggests that decreasing tibial slope may be protective in an ACL deficient knee. Hence by placing the tricortical graft posterior to midline in the opening wedge reduces the posterior tibial slope and thereby reduces the stress on the graft leading to better functional outcome.
-
Arch Orthop Trauma Surg · Apr 2016
Case ReportsChance fracture in an older patient with positive sagittal imbalance and previous lumbar arthrodesis: what can be done?
The Chance fracture occurs frequently in school-aged patients' population and is related to flexion-distraction injury in motor vehicle accidents. It is so called seat-belt syndrome because the seatbelt lies over the abdomen. ⋯ We present an 82 years old patient who suffered unrecognized Chance fracture after a low energy fall. The management of this patient with positive sagittal imbalance and previous arthrodesis consisted of decompression, Smith-Petersen osteotomy and posterior pedicle screw instrumentation.
-
Arch Orthop Trauma Surg · Apr 2016
Case ReportsIrreducible plantar dislocation of the interphalangeal joint of the great toe due to an accessory sesamoid bone: a case report.
Great toe dislocation frequently occurs at the metatarsophalangeal joint. However, an irreducible dislocation of the great toe interphalangeal (IP) joint due to an accessory sesamoid bone is relatively unusual. ⋯ The sesamoid bone at the IP joint is anatomically located dorsal to the flexor hallucis longus tendon and volar plate. The sesamoid bone fitted exactly in the distal intercondylar area. The sesamoid bone in our patient could be rotated by forcible plantar flexion of the IP joint displaced proximally and hooked into the intercondylar area from the proximal aspect. Then, the distal phalanx was pulled proximally through the volar plate. This is the first report on a plantar dislocation of the IP joint.
-
Arch Orthop Trauma Surg · Apr 2016
A new classification system of patellar instability and patellar maltracking.
To date there is no classification of patellar dislocations considering clinical and radiological pathologies. As a result many studies mingle the dislocation's underlying pathologies, so that there are no consistent therapy recommendations. It is this article's objective to introduce a patellar dislocation classification based on the current literature to allow for the application of a structured diagnosis and treatment algorithm. ⋯ Maltracking can only be fixed by means of corrective osteotomy. The classification is referenced to current literature and each type is introduced by a case example. The resulting treatment consequence is also presented.
-
Arch Orthop Trauma Surg · Apr 2016
Randomized Controlled Trial Comparative StudyNo significant difference in clinical outcome and knee stability between patellar tendon and semitendinosus tendon in anterior cruciate ligament reconstruction.
ACL reconstruction with either patellar tendon or semitendinosus tendon autografts are standard procedures. Between these two grafts might be differences in stability, morbidity, or long-term changes. This study investigates outcomes of ACL reconstruction with patellar tendon versus semitendinosus tendon autografts. We hypothesize no significant differences in clinical outcome and knee stability between both groups. ⋯ Both, patellar tendon and semitendinosus tendon are safe autografts for ACL reconstruction. Regarding graft selection, individual patient-dependent factors should be considered. ACL reconstruction cannot fully restore pre-injury status of knee joint function in the majority of cases.